Certified Medical Coder

MJHS is a large not-for-profit health system in the Greater New York area. Our range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care at Menorah and Isabella Centers, and the research based MJHS Institute for Innovation and Palliative Care. We also offer Elderplan/HomeFirst: health plans for Medicare and dual-eligible individuals. As a not-for-profit organization, many of our programs and services are made possible through the generosity of grateful families, corporate donors and grants, as well as our own employees. Our MJHS Medical Associates, P.C. is a group of Nurse Practitioners, Physician Assistants, RN Case Managers and LPN's who provide care to Elderplan members who are residents of assisted living and long term care facilities, as well as to those living at home. Supports medical professional corporation procedural and diagnostic coding of medical records for billing. Works with professional and non-professional staff for timely record review and ensuring accuracy of medical documentation and sequencing ensuring that codes meet required legal and insurance rules. Works with internal and external billing staff to ensure timely and complete billing of claims and encounters. Collaborates and corresponds with insurance companies and health care professionals to resolve claim denials. Maintains medical records both electronically and hard copies, maintains productivity and chart metrics. Collaborate with management staff for process improvement, project work. Performs compliance audits regarding billing, procedural and diagnostic coding to ensure documentation is accurate and timely. Submits statistical data for analysis and research by other departments. Able to handle multiple priorities. Key Responsibilities Collaborate with health plan leadership and third-party vendor to plan and conduct education initiatives to improve and enhance clinical documentation. Assist in developing and implementing monitoring programs, policies, and procedures of review process. Develop and execute reporting tools for monitoring. Review and complete procedural and diagnostic coding of medical visits and encounters ensuring compliance with current legal standards. Interact with third parties to resolve payment denials and medical record requests. Collaborate with finance to generate revenue cycle reporting on key financial indicators including visit volume, coded, billed, paid, denied, rebilled and write off. Maintains and secures medical records for professional corporation. Makes management aware of issues related to incomplete work and/or problem areas. Accurately prepares medical record documentation for internal and external audits. Assist manager with all departmental initiatives. Qualifications Associates degree required. Bachelor's degree preferred. Required coding certification (CCS-P or CPC through AHIMA/AAPC). Requires at least 1 year of medical record coding and record review experience. ICD-10 certified, knowledge and experience in CPT codes required. Proficiency with electronic medical records (EMR) or electronic health record (EHR) required. Certified Risk Adjustment Coder (CRC) preferred. Experience working with managed care health organization and outpatient medical practice preferred. Ability to work independently and collaboratively within a team environment to ensure that changes and encounters are posted accurately and timely. Able to multi-task and meet deadlines. Excellent problem-solving skills. Must have excellent interpersonal and communication skills including written, oral and active listening skills. Intermediate Excel, MS Word, Access data entry and report generation. Must have excellent written and oral communication skills, active listening skills. Medical terminology and coding both ICD-9 and ICD-10, CPT required. Experience in internal and external audits required. Knowledge of billing cycle required. #J-18808-Ljbffr Metropolitan Jewish Health System, Inc.